PERFECT

Self management and monitoring

Warfarin, a vitamin K antagonist, has been established as an anticoagulant treatment option for more than 60 years. When used appropriately, warfarin is effective in stroke prevention, reducing the risk of AF-related stroke by 64%.1

Warfarin has a narrow therapeutic window and multiple food and drug interactions, necessitating close monitoring of the drug’s effect on a patient through the international normalised ratio (INR) blood test. The effect of warfarin is strongly linked to the level of INR.

The self-monitoring of INR is an option for motivated patients on long-term warfarin treatment or those supported by a carer to monitor for them. Patient self-testing and self-management can improve anticoagulation control. Some studies have shown a statistically significant reduction in thromboembolic events for patients testing their own INRs compared with standard care, and a halving of the risk of mortality in participants with artificial heart valves.

Self-monitoring utilises a handheld device and a drop of blood taken from a finger prick test to measure the INR. In September 2014, NICE recommended the increased use of self-monitoring for appropriate patients on warfarin and approved the use of a point-of-care test (POCT) device.2

The evidence for self-monitoring is
robust and is set out in depth within the NICE guidance. In most studies reviewed within the guidance, there was no significant difference between self-monitoring (and self-management) and standard care and adherence was not found to be problematic.

Self-monitoring is not widely available in the NHS but is a robust and well tested method of anticoagulant care for appropriate patients. It is a key element of a high-quality anticoagulation service and in circumstances where patient access to face to face care is challenging to deliver, remote self-monitoring of INR should be made available. Self-monitoring must be given suitable attention in anticoagulation service commissioning plans, including a clear process for its utilisation and for the funding of PCOT devices and testing strips. In the resources section you will find a case study on self-monitoring of Warfarin with some helpful tips from the Innovation Agency, patient information leaflets and a framework for adult patients who self-monitor their INR from the London Stroke Clinical Network.

Featured Resources

Pan-London information on patient self monitoring Link

Coagulators are used to monitor blood clotting using a standardised number called the International Normalised Ratio (INR) in people ... read more

Self-monitoring of INR in Warfarin management of patients with Atrial Fibrillation

The aim of this evaluation was to determine the effectiveness, acceptability and practicalities of the introduction of a read more

Innovation Agency Case Study – Warfarin Patients Self-Monitoring

Patients in East Lancashire are using technology and an app to monitor their atrial fibrillation (AF) at home. Around 200 people are ... read more

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